| NPI | 1932571403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801098617) |
| 171M00000X Case Manager/Care Coordinator (Licence: MI 6801098617) | |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2023-04-13 |