| NPI | 1356562177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801059815) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801059815) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6801059815) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6801059815) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2017-04-11 |