NPI | 1215693403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW19138) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW19138) |
Enumeration Date | 2021-11-11 |
Last Update Date | 2024-10-21 |