NPI | 1750614053 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149008608) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00009593) |
Enumeration Date | 2009-09-17 |
Last Update Date | 2018-05-14 |