| NPI | 1790164465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801096258) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MI 6801096258) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2022-06-01 |