NPI | 1760696256 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010825) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 074242-1) |
Enumeration Date | 2007-05-10 |
Last Update Date | 2020-11-02 |