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 | 2019-12-03 |