| NPI | 1730218900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094685) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 104100000X Social Worker (Licence: KY 4587) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2013-04-08 |