| NPI | 1659074508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801120208) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW21382) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2025-09-08 |