NPI | 1104399260 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2002046) |
Additional Taxonomies | 104100000X Social Worker (Licence: AZ LMSW-16798) |
Enumeration Date | 2019-01-10 |
Last Update Date | 2021-07-14 |