NPI | 1255103222 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 18155) |
Additional Taxonomies | 104100000X Social Worker (Licence: LA 18155) |
104100000X Social Worker (Licence: NY 111089-01) | |
171M00000X Case Manager/Care Coordinator (Licence: LA 18155) | |
Enumeration Date | 2023-10-24 |
Last Update Date | 2024-10-08 |