| NPI | 1528211232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI L910594) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA LCSW28901) |
| Enumeration Date | 2008-10-25 |
| Last Update Date | 2015-02-04 |