| NPI | 1437699659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801107986) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802088525) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2026-09-28 |