| NPI | 1821588294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801113515) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801102170) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2022-08-03 |