| NPI | 1952945826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6802090559) |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2022-03-03 |