| NPI | 1023503257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801102632) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2022-07-06 |