NPI | 1649265075 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 110802) |
Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 32412) |
Enumeration Date | 2005-09-12 |
Last Update Date | 2023-01-06 |