NPI | 1912340936 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801094739) |
Additional Taxonomies | 174400000X Specialist (Licence: MI L2476097) |
Enumeration Date | 2013-04-09 |
Last Update Date | 2019-08-15 |