| NPI | 1174163851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851119314) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2025-01-31 |