| NPI | 1952583791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801091755) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802085061) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2025-10-28 |