| NPI | 1629035563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801079564) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801074985) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2011-03-10 |