| NPI | 1982533394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2002002749) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801114925) |
| Enumeration Date | 2026-05-14 |
| Last Update Date | 2026-05-14 |