| NPI | 1376115550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6852090687) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-10-29 |