| 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 |