| NPI | 1316279821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801091572) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 64500) |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2019-12-19 |