NPI | 1215940986 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801019125) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6801019125) |
Enumeration Date | 2006-08-14 |
Last Update Date | 2011-05-20 |