| NPI | 1548099724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801119436) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 1120123) |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2025-04-10 |