NPI | 1376162024 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PR 15286) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 24478) |
Enumeration Date | 2020-04-13 |
Last Update Date | 2020-09-15 |