| NPI | 1427423359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801111032) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI T-00057) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801111032) | |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2022-03-21 |