| NPI | 1376236711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6851116293) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851116293) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-06-01 |