| NPI | 1164969846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801105043) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801100570) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2025-12-16 |