NPI | 1780930420 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 680110797) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH 1100085) |
Enumeration Date | 2012-07-31 |
Last Update Date | 2019-08-21 |