| NPI | 1730604232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851120273) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MI 6803087041) |
| 247200000X Technician, Other | |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2025-10-17 |