| NPI | 1023429198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801096571) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2024-11-04 |