| 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 |