| NPI | 1649410564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801091167) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6802078461) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2014-10-15 |