NPI | 1720195951 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 1077) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 30378) |
Enumeration Date | 2006-08-24 |
Last Update Date | 2024-10-15 |