| NPI | 1265528996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801016909) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301002552) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2011-09-12 |