NPI | 1114083110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider |
Additional Taxonomies | 101YS0200X Counselor, School |
104100000X Social Worker | |
1041S0200X Social Worker, School | |
Enumeration Date | 2006-12-28 |
Last Update Date | 2025-09-11 |