| NPI | 1760033070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801079304) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker (Licence: MI 6801079304) | |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2024-12-06 |