| NPI | 1538213103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801093325) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 007303) |
| 1041C0700X Social Worker, Clinical (Licence: NY 076562) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2011-10-20 |