| NPI | 1366227589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801120132) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6851115451) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2025-06-17 |