| NPI | 1679958664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6802062018) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI SA0150013) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2023-06-15 |