| NPI | 1710179148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801106665) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6803085707) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2020-03-30 |