NPI | 1376919944 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 19365) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904015436) |
1041C0700X Social Worker, Clinical (Licence: DC LG50080686) | |
Enumeration Date | 2015-08-18 |
Last Update Date | 2023-10-18 |