| NPI | 1750074332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801117394) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851094683) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2025-07-24 |