| NPI | 1215302153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801099013) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149016647) |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2016-02-09 |