NPI | 1801056932 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 13757) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 101160) |
Enumeration Date | 2008-06-12 |
Last Update Date | 2021-12-17 |