| NPI | 1861533127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114168) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.00001167) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2024-06-17 |