| NPI | 1396360822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114449) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801106690) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2023-07-17 |