| NPI | 1588110613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114438) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801103956) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2022-09-07 |