| NPI | 1962926899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401018194) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-03905) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401018194) | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2024-10-08 |