| NPI | 1861945479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801116996) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801099259) |
| Enumeration Date | 2016-07-31 |
| Last Update Date | 2023-09-14 |