NPI | 1740511849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00940427) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 15617) |
1041C0700X Social Worker, Clinical (Licence: VA 0904007035) | |
Enumeration Date | 2010-01-29 |
Last Update Date | 2012-07-17 |