| NPI | 1255303715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801068896) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: MI 6801068896) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2007-07-08 |