NPI | 1508358508 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW17358) |
Additional Taxonomies | 104100000X Social Worker (Licence: NY 102155) |
Enumeration Date | 2018-06-05 |
Last Update Date | 2023-03-22 |