NPI | 1467515551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904002208) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC00300287) |
Enumeration Date | 2006-12-19 |
Last Update Date | 2007-07-08 |