| NPI | 1922277052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094548) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802082049) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2012-07-09 |