NPI | 1467423368 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.002173) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 33730) |
Enumeration Date | 2006-01-30 |
Last Update Date | 2007-07-08 |