| NPI | 1023788650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801119757) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW21875) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2025-07-23 |