| NPI | 1639793680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801120394) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851107151) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2026-04-23 |