| NPI | 1689872913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801089466) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 33004521A) |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2015-11-04 |