| NPI | 1912039314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34004438A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801089471) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2021-02-12 |