| NPI | 1609406909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801109069) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 086839) |
| Enumeration Date | 2020-01-25 |
| Last Update Date | 2021-05-11 |