| 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 |