| NPI | 1518374297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0906016293) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801094159) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2025-04-13 |