| NPI | 1699225961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 72132) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801099538) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |