| 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 |