| NPI | 1033515317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928467) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801089941) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2024-10-26 |