| NPI | 1942741301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801010281) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MI 6801010281) |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2017-03-17 |