| NPI | 1740659218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401019593) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 6401019593) |
| 101YM0800X Counselor Mental Health (Licence: MI 6401019593) | |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2022-12-13 |