| NPI | 1851420848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 60925) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401007633) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-25 |