| NPI | 1053741199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801110264) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6802087531) |
| 247200000X Technician, Other | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2021-06-25 |