NPI | 1346810363 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 013352) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 128490) |
Enumeration Date | 2021-06-30 |
Last Update Date | 2024-12-30 |