| NPI | 1235303991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924587) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801082270) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2025-01-13 |