| NPI | 1548944630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6851116571) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2023-06-09 |