NPI | 1255668687 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C011313) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2009-11-05 |
Last Update Date | 2024-02-05 |