| NPI | 1902363187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114807) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851103776) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801103776) | |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2022-07-08 |