| NPI | 1831310697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801034179) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH 0010140) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |