| NPI | 1952964710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW16260) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801103745) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2020-04-10 |