| NPI | 1982983797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801093466) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2019-03-12 |