NPI | 1518181635 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 17745) |
Additional Taxonomies | 104100000X Social Worker (Licence: NY 069265) |
Enumeration Date | 2007-04-12 |
Last Update Date | 2014-06-09 |