NPI | 1871258178 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801116621) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW023664) |
Enumeration Date | 2021-11-02 |
Last Update Date | 2024-01-11 |