| NPI | 1124010137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801077207) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 110306) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2012-11-08 |