NPI | 1114141520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6895) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L6138) |
1041C0700X Social Worker, Clinical (Licence: NM I-06318) | |
Enumeration Date | 2007-04-13 |
Last Update Date | 2022-05-02 |