NPI | 1124184395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123908) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 25909) |
Enumeration Date | 2006-12-29 |
Last Update Date | 2024-03-06 |