NPI | 1245760313 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC60774690) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
1041C0700X Social Worker, Clinical (Licence: ID LCSW-40920) | |
Enumeration Date | 2017-06-12 |
Last Update Date | 2023-02-06 |