| NPI | 1912340936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094739) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI L2476097) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2019-08-15 |