| NPI | 1407148364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2013033736) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801115644) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2023-01-30 |