| NPI | 1003164245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801093133) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-01173) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801093133) | |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2019-10-16 |