| NPI | 1912154824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS3259) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801064086) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2008-08-21 |