NPI | 1871000224 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801105924) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801100457) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-03797) | |
Enumeration Date | 2018-01-08 |
Last Update Date | 2019-10-31 |