| NPI | 1063042414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851106052) |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2023-04-28 |