| NPI | 1629708961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114812) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928144) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2025-07-21 |