| NPI | 1134715154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851122445) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2026-07-08 |