| NPI | 1942416706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401009346) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MI 3203052217) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C00806) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15273-132) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ZZ 201261) | |
| 101YP2500X Counselor, Professional (Licence: FL MH19364) | |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401009346) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2025-12-30 |