NPI | 1285961433 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60951098) |
Additional Taxonomies | 101YS0200X Counselor, School (Licence: NM I-06049) |
Enumeration Date | 2009-11-09 |
Last Update Date | 2019-09-17 |