| NPI | 1679874432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 51570) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801087240) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2010-11-10 |