| NPI | 1962727305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34003612A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801066829) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2019-11-04 |