| NPI | 1578555397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 22698) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2006029483) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801076311) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2022-07-21 |