| NPI | 1013952167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801019786) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 00572) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2018-03-21 |