| NPI | 1922651041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801117121) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801101413) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801117121) | |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2025-09-29 |