| NPI | 1154648509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801097967) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 27452) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2467) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-02940) | |
| 1041C0700X Social Worker, Clinical (Licence: NC P007900) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 150.012251) | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2023-02-13 |