NPI | 1871873554 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008047) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW18404) |
Enumeration Date | 2011-08-25 |
Last Update Date | 2021-09-17 |