NPI | 1144091505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149025844) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 149025844) |
Enumeration Date | 2024-01-12 |
Last Update Date | 2024-02-22 |