NPI | 1194346858 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087356) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 91959) |
Enumeration Date | 2020-05-04 |
Last Update Date | 2024-07-08 |