NPI | 1336428879 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094209) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
104100000X Social Worker (Licence: MI 6801094209) | |
Enumeration Date | 2011-08-16 |
Last Update Date | 2025-08-20 |