| NPI | 1366556672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801012121) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301007222) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2025-09-11 |