| NPI | 1952859431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801101102) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI MCBAP Dev Plan) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2018-03-17 |