| NPI | 1073002002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 7310-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801091309) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-05-04 |