| NPI | 1659186708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 135215-121) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 20459-130) |
| 104100000X Social Worker (Licence: MI 6851119332) | |
| 405300000X Prevention Professional (Licence: WI 17013-137) | |
| Enumeration Date | 2025-02-07 |
| Last Update Date | 2025-02-07 |