NPI | 1689905531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 6720347-3501) |
Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO CSW-1417) |
Enumeration Date | 2010-01-15 |
Last Update Date | 2022-03-15 |