| NPI | 1467061556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801115185) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801107468) |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2023-11-06 |