| NPI | 1598114936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801073262) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: MI 6801073262) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2026-04-17 |