NPI | 1245847391 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149025305) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 149025305) |
Enumeration Date | 2020-09-23 |
Last Update Date | 2025-01-15 |