| NPI | 1821034638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801019131) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301002268) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2011-07-28 |