| NPI | 1942546833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 56663) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI SPADA Certification) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401009072) | |
| 101YS0200X Counselor, School | |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2022-07-15 |