NPI | 1356676852 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904010254) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 8806) |
Enumeration Date | 2009-10-16 |
Last Update Date | 2022-10-25 |