NPI | 1194964643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 6221752-3501) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 62217523502) |
Enumeration Date | 2009-02-06 |
Last Update Date | 2015-08-12 |