| NPI | 1811921901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401002426) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401002426) |
| 101YP2500X Counselor, Professional (Licence: MI 6401002426) | |
| 101YS0200X Counselor, School (Licence: MI 6401002426) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2009-04-17 |