| NPI | 1811449861 |
|---|---|
| Other Name | MICKY MACK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW95367) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 225A00000X Music Therapist | |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2020-08-02 |