NPI | 1134465263 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 4127C) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.014379) |
Enumeration Date | 2012-12-18 |
Last Update Date | 2018-10-21 |