NPI | 1659365039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2004031337) |
Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ID LCSW-25690) |
Enumeration Date | 2005-08-31 |
Last Update Date | 2008-02-11 |