| NPI | 1396783205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6141) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301009409) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801074389) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-04-22 |