| NPI | 1487028510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801098375) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 105520) |
| 171M00000X Case Manager/Care Coordinator (Licence: MI 6801098375) | |
| 104100000X Social Worker (Licence: MI 6801098375) | |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2023-10-06 |