| NPI | 1679816359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801095444) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801095444) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2025-12-03 |