| NPI | 1245707280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801106533) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801102197) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2022-03-27 |