| NPI | 1689124117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401223787) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2024-06-06 |