| NPI | 1124552278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801104870) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801100865) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2017-04-16 |
| Last Update Date | 2020-02-25 |