| NPI | 1891838157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 410049 and 310069) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 6301005463) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |