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 |