| NPI | 1629559927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801114409) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801102317) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2023-10-05 |