| NPI | 1831222504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6801060415) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6801060415) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801060415) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2013-10-23 |