NPI | 1104846575 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 804) |
Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TN LSW0000000611) |
Enumeration Date | 2006-07-20 |
Last Update Date | 2019-05-06 |