| NPI | 1215447123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851114972) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2022-06-07 |