NPI | 1255721403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 16607) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 09040008836) |
Enumeration Date | 2015-01-27 |
Last Update Date | 2015-01-27 |