| NPI | 1043749534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801108897) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801100913) |
| 104100000X Social Worker (Licence: MI 6801108897) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-11-10 |