| NPI | 1013560085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801113617) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801104742) |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2021-11-11 |