| NPI | 1699420042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801119337) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851114037) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2025-02-26 |