| NPI | 1639577448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI M-00011) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801096425) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801096425) | |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2023-03-23 |