| NPI | 1881624146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801013086) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI CAC-I,SAP) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301003780) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2013-07-10 |