| NPI | 1700086634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801064406) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301007482) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2015-01-22 |