| NPI | 1356908651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801104363) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6801104363) |
| 104100000X Social Worker (Licence: MI 6801104363) | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2021-08-11 |