NPI | 1578840005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5962187-3501) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 5955-C) |
Enumeration Date | 2011-11-11 |
Last Update Date | 2022-10-06 |