NPI | 1659749224 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L15610) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 12267) |
1041C0700X Social Worker, Clinical (Licence: CA 81356) | |
Enumeration Date | 2015-09-12 |
Last Update Date | 2025-04-09 |