NPI | 1063564516 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 5575) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 113374) |
1041C0700X Social Worker, Clinical (Licence: 211886) | |
Enumeration Date | 2007-01-17 |
Last Update Date | 2012-04-28 |