NPI | 1770705774 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 18821) |
Additional Taxonomies | 167G00000X Licensed Psychiatric Technician |
Enumeration Date | 2007-05-02 |
Last Update Date | 2012-10-15 |