NPI | 1861034852 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801112405) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851106080) |
Enumeration Date | 2019-10-11 |
Last Update Date | 2022-08-23 |