| NPI | 1881212777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851110214) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801110214) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2023-09-27 |