| NPI | 1174173876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801115359) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6851108233) |
| 104100000X Social Worker | |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2022-10-06 |