| NPI | 1831766377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851109712) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2022-03-28 |