| NPI | 1790207272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801104963) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801100948) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2022-07-29 |