NPI | 1093731259 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-18005) |
Additional Taxonomies | 104100000X Social Worker (Licence: FL MH2815) |
101YM0800X Counselor, Mental Health (Licence: FL MH2815) | |
Enumeration Date | 2006-07-14 |
Last Update Date | 2022-10-20 |