| NPI | 1720594260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801121381) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2026-04-01 |