NPI | 1659305308 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801057938) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6801057938) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2009-03-23 |