NPI | 1114002631 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801059457) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 466-123) |
Enumeration Date | 2006-10-25 |
Last Update Date | 2010-11-07 |