NPI | 1386714640 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1015836) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 003129) |
Enumeration Date | 2006-11-08 |
Last Update Date | 2021-02-01 |