| NPI | 1023563988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801067489) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2016-08-22 |