| NPI | 1053750695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801095453) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6801095453) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6801095453) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2025-07-09 |