| NPI | 1972019610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801115428) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6802089485) |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2023-01-18 |