| NPI | 1881108405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801112356) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801101704) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09927195) | |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2023-01-13 |