| NPI | 1548200462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801091525) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 3222063501) |
| 1041C0700X Social Worker, Clinical (Licence: OH I1500231) | |
| 1041C0700X Social Worker, Clinical (Licence: AL 1999C) | |
| 1041C0700X Social Worker, Clinical (Licence: MS C6753) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-11-16 |