| NPI | 1508547159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801121434) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851117079) |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2025-12-15 |