| NPI | 1982064002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401017764) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401015306) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2021-04-19 |