| NPI | 1932179058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 197) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801071538) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2007-07-08 |