| NPI | 1700946027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801089549) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA LCS22956) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2008-11-07 |