NPI | 1073873055 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094040) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2012-05-23 |
Last Update Date | 2017-03-09 |