| NPI | 1134194467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801034036) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 05842) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801034036) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2013-09-20 |