| NPI | 1306481023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801116516) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801100197) |
| Enumeration Date | 2019-11-18 |
| Last Update Date | 2024-05-17 |