| NPI | 1992478390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801115703) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801104665) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801104665) | |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2023-07-07 |