| NPI | 1891977948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 2055942) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: MI 2055942) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-11-30 |