| NPI | 1750727236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801102071) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6801102071) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 680141564) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6801102071) | |
| 101YM0800X Counselor, Mental Health (Licence: MI 6801102071) | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2022-08-22 |