NPI | 1750604856 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 15397) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 075220) |
Enumeration Date | 2010-03-04 |
Last Update Date | 2016-05-19 |