NPI | 1164879763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 010414) |
Additional Taxonomies | 101Y00000X Counselor |
101YM0800X Counselor Mental Health | |
106H00000X Marriage & Family Therapist | |
Enumeration Date | 2016-05-24 |
Last Update Date | 2019-03-04 |