| NPI | 1053800979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW20818) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801106905) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6851106905) | |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801114905) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2023-04-10 |