NPI | 1114976503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801019810) |
Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801019810) |
Enumeration Date | 2006-05-10 |
Last Update Date | 2021-06-04 |