| NPI | 1356773634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI L283307) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI L283307) |
| 101YM0800X Counselor Mental Health (Licence: MI L283307) | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2018-12-21 |