| NPI | 1922305069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW20128) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801094310) |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2024-07-16 |