| NPI | 1861645368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 822974) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 1861645368) |
| 175T00000X Peer Specialist (Licence: MI 1861645368) | |
| 2279E1000X Respiratory Therapist, Registered, Educational | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2019-09-18 |