NPI | 1023524303 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801118667) |
Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851101342) |
Enumeration Date | 2017-12-21 |
Last Update Date | 2024-06-18 |