NPI | 1205024619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 007447) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 076177) |
Enumeration Date | 2007-10-10 |
Last Update Date | 2024-04-01 |