| NPI | 1508386814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6851113986) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 100115) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-04-23 |