| NPI | 1154091809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851116892) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2025-06-13 |