NPI | 1629101233 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005586) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 075641) |
Enumeration Date | 2007-03-13 |
Last Update Date | 2010-03-05 |