| NPI | 1538273743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801115195) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 1187) |
| 1041C0700X Social Worker, Clinical (Licence: IN 34003875A) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2024-02-22 |