| NPI | 1275074262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801116110) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC 60708502) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149020299) | |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2024-04-11 |