| NPI | 1053046409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801119627) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851115130) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2025-01-09 |