| NPI | 1275876070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801103532) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801103532) |
| 1041C0700X Social Worker, Clinical (Licence: MN 19819) | |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2026-06-25 |