NPI | 1285652370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW7101) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC9524) |
1041C0700X Social Worker, Clinical (Licence: GA CSW002292) | |
Enumeration Date | 2006-07-17 |
Last Update Date | 2015-01-06 |