| NPI | 1245623776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114971) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2023-05-25 |