| NPI | 1972988608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801115063) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2023-10-31 |