| NPI | 1154779973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801106589) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801099494) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2021-01-05 |