| NPI | 1609349174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801118899) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801103545) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2024-08-29 |