| NPI | 1982145009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW123251) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801105850) |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2023-10-16 |