| NPI | 1518224419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 107495) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802085802) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2023-03-21 |