NPI | 1346320454 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801062435) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6401002793) |
103TC0700X Psychologist Clinical (Licence: MI 6301005924) | |
Enumeration Date | 2006-10-16 |
Last Update Date | 2011-05-12 |