| NPI | 1215451646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851101177) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801101177) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2021-09-13 |