| NPI | 1669814778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6803082583) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 1-04119) |
| 224Z00000X Occupational Therapy Assistant (Licence: MI 5202005476) | |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2013-07-18 |