| NPI | 1023116555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: 6801015687) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801015687) |
| 104100000X Social Worker (Licence: MI 6801015687) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-11-19 |