| NPI | 1922490614 |
|---|---|
| Other Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801116822) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801099895) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2023-08-17 |