| NPI | 1093080335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801118659) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI CSW03819) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2024-08-06 |