| NPI | 1891279667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 29297) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801100595) |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2021-02-01 |