| NPI | 1871610576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401006157) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI C-00165) |
| 101YS0200X Counselor School (Licence: MI SC0000380) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2015-03-19 |