NPI | 1629068622 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-1205) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 8830-123) |
Enumeration Date | 2005-10-21 |
Last Update Date | 2019-09-10 |