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 |