NPI | 1366878084 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: DE CW016737) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA SW128063) |
101YM0800X Counselor Mental Health (Licence: DE CW016737) | |
1041C0700X Social Worker Clinical (Licence: PA SW128063) | |
Enumeration Date | 2013-09-26 |
Last Update Date | 2016-10-21 |