| NPI | 1538761390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801116077) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801108399) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2023-05-22 |