| NPI | 1609848035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801102033) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 16394) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2018-11-27 |