NPI | 1538293030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801084804) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 6801084804) |
Enumeration Date | 2007-03-15 |
Last Update Date | 2018-11-12 |