| NPI | 1790923993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801061702) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801061702) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2024-06-01 |