NPI | 1851420848 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MI 60925) |
101YP2500X Counselor, Professional (Licence: MI 6401007633) | |
Enumeration Date | 2007-03-05 |
Last Update Date | 2025-09-11 |