| NPI | 1366798365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094817) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2024-06-04 |