NPI | 1588020846 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801103889) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI L364683792106) |
101YM0800X Counselor, Mental Health (Licence: MI L364683792106) | |
Enumeration Date | 2016-01-01 |
Last Update Date | 2024-02-21 |