| NPI | 1063809846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801110122) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI M286754) |
| 247200000X Technician, Other | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2021-10-25 |