| NPI | 1528461837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 25837) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6801096314) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2021-08-16 |