| NPI | 1023542842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801106731) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801097124) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2021-04-30 |