| NPI | 1821592296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801108948) |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 14677) |
| 1041C0700X Social Worker, Clinical (Licence: LA 14677) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2024-08-28 |