NPI | 1790299428 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 12861) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904009680) |
Enumeration Date | 2017-11-16 |
Last Update Date | 2020-09-23 |