| NPI | 1043614530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801071297) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: MI 6301071297) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2014-10-13 |