| NPI | 1063201267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6851121655) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2026-05-27 |