| NPI | 1083262844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09930176) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801103348) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2024-09-05 |