| NPI | 1427503150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801104349) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801099949) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2019-05-16 |