| NPI | 1932862687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801120493) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851111225) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2025-07-15 |