| NPI | 1154762052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801099644) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801099644) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2025-10-08 |