NPI | 1649923822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 96977) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 105022) |
Enumeration Date | 2022-01-28 |
Last Update Date | 2022-01-28 |