| NPI | 1952188252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801120555) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 14233403-3501) |
| 1041C0700X Social Worker, Clinical (Licence: CO 09931988) | |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2506852) | |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2025-09-19 |