NPI | 1164988903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801110237) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801103839) |
Enumeration Date | 2019-02-18 |
Last Update Date | 2021-07-15 |