NPI | 1225564982 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 14279) |
Enumeration Date | 2017-05-02 |
Last Update Date | 2022-06-16 |