| NPI | 1659612778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801098343) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DC LG50079539) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2016-05-24 |