| NPI | 1699963074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801105017) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2021-03-26 |