NPI | 1134474927 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C016443) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC C016443) |
Enumeration Date | 2012-07-17 |
Last Update Date | 2023-10-18 |