NPI | 1003170838 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 5416) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ 13543) |
Enumeration Date | 2012-06-26 |
Last Update Date | 2012-06-26 |