| NPI | 1336897412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801122747) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09933530) |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2026-08-25 |