| NPI | 1417349176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA 61196656) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6802088156) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2025-10-22 |