NPI | 1629366968 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7935) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 17719) |
Enumeration Date | 2011-07-20 |
Last Update Date | 2024-01-29 |