NPI | 1588063929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2016003045) |
Additional Taxonomies | 104100000X Social Worker (Licence: KS 9318) |
Enumeration Date | 2014-08-21 |
Last Update Date | 2016-10-12 |