| NPI | 1568841989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801098362) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802088543) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2018-08-09 |