| NPI | 1609349174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801118899) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801118899) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2025-04-30 |