| NPI | 1609975671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801018152) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2024-01-30 |