| NPI | 1083004147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801107695) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801096445) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2023-02-01 |