| NPI | 1396456661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q3-0011337) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851115883) |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2024-06-27 |