| NPI | 1841507316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801016033) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.012903) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2010-09-07 |