| NPI | 1548629728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801119239) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801098816) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2024-11-02 |