| NPI | 1407595580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801117083) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851096046) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2024-04-01 |