| NPI | 1508400011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801103770) |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2025-05-20 |