| NPI | 1982210365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801118271) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2607621) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2026-08-10 |