| 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 |