| NPI | 1073206512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801121611) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-01317) | |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2026-06-22 |