NPI | 1174905459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008789) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0904008789) |
Enumeration Date | 2015-06-23 |
Last Update Date | 2023-11-16 |