Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LMSW-37838 | ID |
NPI | 1003468521 |
---|---|
Provider Name | Daniel James Griffin |
First Address | Boise, ID 83713-5104 |
Second Address | Boise, ID 83713-5104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2019 |
Last Update Date | 15/07/2019 |