NPI | 1366141566 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801109032) |
Additional Taxonomies | 104100000X Social Worker (Licence: NY 101431-1) |
Enumeration Date | 2023-02-27 |
Last Update Date | 2023-02-27 |