| NPI | 1699317461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801113906) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801105759) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2021-12-21 |