| NPI | 1700235843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401015161) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401015161) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401015161) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-06-09 |