NPI | 1104184738 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-30107) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
101YM0800X Counselor, Mental Health (Licence: ID 30107) | |
Enumeration Date | 2012-05-02 |
Last Update Date | 2021-07-01 |