| NPI | 1255805685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801109360) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801103692) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2021-04-09 |