NPI | 1215290069 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 28894) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904007884) |
Enumeration Date | 2012-06-18 |
Last Update Date | 2015-02-09 |