| NPI | 1306096953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI L1916956) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 1-04857) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2011-07-01 |