NPI | 1861533127 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801114168) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.00001167) |
Enumeration Date | 2007-02-09 |
Last Update Date | 2024-06-17 |