| NPI | 1831237288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801065431) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301007141) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2025-09-11 |