| NPI | 1609920560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 100321) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401005779) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6301007668) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |