| NPI | 1093344681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801106998) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801114888) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2023-02-28 |