| NPI | 1184785883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801082767) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 19884) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2018-04-20 |