| NPI | 1528110665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 9722) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 680106883) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2012-03-14 |