NPI | 1497158984 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121794) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 222138) |
Enumeration Date | 2014-09-29 |
Last Update Date | 2020-02-19 |