NPI | 1174302285 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical |
Additional Taxonomies | 1041S0200X Social Worker, School (Licence: IL 2600972) |
104100000X Social Worker (Licence: MO 20220002656) | |
Enumeration Date | 2023-09-27 |
Last Update Date | 2024-08-23 |