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 |