NPI | 1013215201 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 5572) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW16165) |
Enumeration Date | 2011-03-11 |
Last Update Date | 2024-03-15 |