| NPI | 1841719614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801104833) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6801104833) | |
| 104100000X Social Worker (Licence: MI 6801114818) | |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2024-08-15 |