| NPI | 1639634967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851106843) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 34673) |
| 104100000X Social Worker (Licence: IL 150.103338) | |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2021-11-23 |