| NPI | 1649318940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-00116) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 1811089) |
| 1041C0700X Social Worker, Clinical (Licence: MI 1757155) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-07-08 |