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 |