| NPI | 1558896506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-40831) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928268) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801117495) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2024-04-07 |