NPI | 1255340832 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 1656) |
Additional Taxonomies | 251S00000X Community/Behavioral Health |
Enumeration Date | 2006-08-05 |
Last Update Date | 2017-08-28 |