| NPI | 1144602541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801098023) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801098023) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2018-12-12 |