| NPI | 1285373761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851115023) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2025-07-28 |