| NPI | 1043703069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114044) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 156F00000X Technician/Technologist | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2022-06-22 |