NPI | 1003034794 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 12753) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WV DP00941682) |
Enumeration Date | 2007-04-20 |
Last Update Date | 2007-07-08 |