| NPI | 1982618906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 1-00432) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401007535) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801046217) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |