| NPI | 1912290875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801092445) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: MI 4704223546) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2020-10-26 |