| NPI | 1245897545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801111111) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851104293) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801104293) | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2021-09-07 |