| NPI | 1194276394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801115224) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2016-10-23 |
| Last Update Date | 2022-09-21 |