| NPI | 1760418792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801099861) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 06425) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2020-08-07 |