| NPI | 1891237186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851108144) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2024-05-22 |