NPI | 1114910858 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY PR025258) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00126500) |
1041C0700X Social Worker, Clinical (Licence: MA 107681) | |
Enumeration Date | 2005-08-29 |
Last Update Date | 2008-02-26 |