| NPI | 1306223359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801116117) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802082302) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2023-03-29 |