| NPI | 1669001335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801113623) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 680114764) |
| Enumeration Date | 2020-04-05 |
| Last Update Date | 2022-02-10 |