| NPI | 1144496043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801096773) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2021-11-12 |