| NPI | 1255723052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 65580) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802086884) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2021-03-29 |