| NPI | 1487864039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801-070632) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 1-01485) |
| 1041C0700X Social Worker, Clinical (Licence: IA 06511) | |
| 104100000X Social Worker (Licence: MI 6801070632) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2015-04-23 |