| NPI | 1164852208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: MI 6801095887) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801095887) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2014-12-05 |