NPI | 1245699776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.018928) |
Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.015253) |
Enumeration Date | 2016-02-11 |
Last Update Date | 2016-11-01 |