| NPI | 1417306861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801108524) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2025-01-30 |