| NPI | 1740589373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 254440) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6801091712) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2019-10-17 |