| NPI | 1922554161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6802058697) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-01298) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI S-20162) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI D-10011) | |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-08-28 |