| NPI | 1164988903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801110237) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801103839) |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2021-07-15 |