NPI | 1659853158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61410770) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 85360) |
Enumeration Date | 2018-08-30 |
Last Update Date | 2023-06-13 |