| NPI | 1467846527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801097961) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2017-05-09 |