NPI | 1285629378 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 104100000X Social Worker (Licence: MD 2805) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD LCSWC2805) |
Enumeration Date | 2005-09-14 |
Last Update Date | 2015-11-24 |