| NPI | 1831361609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6802073013) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 6802073013) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2015-05-05 |