| NPI | 1003402207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801120101) |
| Enumeration Date | 2020-12-12 |
| Last Update Date | 2025-04-14 |