| NPI | 1629395777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 4101005270) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 4101005270) |
| 101YM0800X Counselor Mental Health (Licence: MI 4101005270) | |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101005270) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2010-04-29 |