NPI | 1629000757 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801059734) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301004044) |
Enumeration Date | 2006-07-07 |
Last Update Date | 2017-01-12 |