| NPI | 1912457516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801110582) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6801100113) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2023-05-24 |