| NPI | 1003259557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801058356) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801058356) |
| 1041S0200X Social Worker, School (Licence: MI 6801058356) | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2013-04-15 |