| NPI | 1821195918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801070294) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6801070294) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6801070294) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-06-24 |