| NPI | 1104252626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801095932) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05879000) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2020-02-22 |