| NPI | 1508974726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801059977) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: MI 4704110516) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2007-07-08 |