NPI | 1760029854 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801117356) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851106067) |
Enumeration Date | 2019-12-08 |
Last Update Date | 2023-11-06 |