| NPI | 1982194569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801107625) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801102622) | |
| 171M00000X Case Manager/Care Coordinator | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 8387) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2026-07-14 |