| NPI | 1821451295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401017030) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401013114) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401017030) | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2022-02-22 |