| NPI | 1942570817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801085944) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MI 6801085944) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2021-12-24 |