| NPI | 1821322454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 104888 CACM) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 25572CSOTS) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2009-09-30 |