NPI | 1386201861 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 87999) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149020632) |
1041C0700X Social Worker, Clinical (Licence: WI 11907-123) | |
Enumeration Date | 2019-05-21 |
Last Update Date | 2024-09-03 |