NPI | 1679073092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801104012) |
Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801100146) |
Enumeration Date | 2018-02-13 |
Last Update Date | 2023-08-08 |