| NPI | 1669096046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801118891) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 6492C) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2026-03-26 |