| NPI | 1336409903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801112081) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2023-09-28 |