| NPI | 1578074373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801101120) |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2023-02-20 |