NPI | 1548443229 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 25449) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 115532) |
Enumeration Date | 2007-12-17 |
Last Update Date | 2012-08-02 |