| NPI | 1376907030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801106662) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801097477) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2020-03-13 |