| NPI | 1043639446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-02603) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2024-08-21 |