NPI | 1114285814 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 104085) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 3534) |
Enumeration Date | 2012-05-01 |
Last Update Date | 2023-08-22 |