| NPI | 1033941679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851119057) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2026-05-28 |