NPI | 1356732945 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW13755) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 17053) |
Enumeration Date | 2015-02-18 |
Last Update Date | 2018-11-06 |