| NPI | 1891404489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6851122027) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2026-06-03 |