| NPI | 1508884370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM c-09359) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801085533) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-03-24 |