| NPI | 1699332007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801104464) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MI 6801104464) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2020-12-07 |