| NPI | 1144360702 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801034737) | 
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005940) | 
| Enumeration Date | 2007-02-06 | 
| Last Update Date | 2025-09-11 |