NPI | 1043660343 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW28575) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00009000) |
Enumeration Date | 2016-06-16 |
Last Update Date | 2016-08-31 |