| NPI | 1114407236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801108147) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801103006) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2020-10-01 |