NPI | 1063536977 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SD 2252) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 34297) |
Enumeration Date | 2007-03-17 |
Last Update Date | 2007-07-08 |