| NPI | 1245576305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094545) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2020-01-07 |