| NPI | 1528380623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094835) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-02622) |
| 103K00000X Behavior Analyst | |
| 104100000X Social Worker | |
| Enumeration Date | 2010-02-17 |
| Last Update Date | 2020-09-13 |