| NPI | 1780296939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801120408) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801095291) |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2025-10-13 |