NPI | 1518322833 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1801160) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 55248) |
Enumeration Date | 2015-12-31 |
Last Update Date | 2019-07-01 |