| NPI | 1699228460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801099711) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801099711) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2020-01-10 |