NPI | 1043760044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09925877) |
Additional Taxonomies | 104100000X Social Worker (Licence: NY 093947) |
Enumeration Date | 2016-10-13 |
Last Update Date | 2019-06-03 |