| NPI | 1801465034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801110468) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801104433) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801104433) | |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2025-01-10 |