| NPI | 1013423060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801106800) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6801101768) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2022-08-31 |