| NPI | 1366418873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801114903) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801114903) |
| 1041C0700X Social Worker Clinical (Licence: NY R0583761) | |
| 1041C0700X Social Worker Clinical (Licence: IL 149023771) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2024-04-05 |