NPI | 1114165651 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801090193) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-01071) |
Enumeration Date | 2009-01-21 |
Last Update Date | 2020-11-10 |