| NPI | 1891108122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801057116) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2014-06-04 |