NPI | 1205160405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001143) |
Additional Taxonomies | 104100000X Social Worker (Licence: NY 079938) |
1041C0700X Social Worker, Clinical (Licence: NY 73 080121) | |
Enumeration Date | 2009-09-22 |
Last Update Date | 2013-02-20 |