| NPI | 1184103814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801106030) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2019-12-09 |