NPI | 1700502564 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904015251) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LG200001767) |
Enumeration Date | 2022-10-13 |
Last Update Date | 2023-04-27 |