| NPI | 1801802822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801002634) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: MI 6801002634) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-05-19 |