NPI | 1366853095 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 10248) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C005272) |
1041C0700X Social Worker, Clinical (Licence: VA 0904006263) | |
Enumeration Date | 2014-05-15 |
Last Update Date | 2014-05-15 |