| NPI | 1376777045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801090144) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MI 6801090144) |
| 172V00000X Community Health Worker (Licence: 6801090144) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2020-03-03 |