| NPI | 1609409994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801120717) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2020-02-15 |
| Last Update Date | 2025-09-15 |