NPI | 1396090981 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094403) |
Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801094403) |
Enumeration Date | 2012-07-19 |
Last Update Date | 2022-07-21 |