| NPI | 1679742928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 1972368) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI S-10019) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-00234) | |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2008-02-20 |