| NPI | 1972941771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801119287) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MI 6803086544) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2025-10-03 |