| NPI | 1194307389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801120277) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: MI 6851109700) | |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2025-08-07 |