| NPI | 1518523877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114502) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801104059) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2022-11-04 |