NPI | 1386246965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW007597) |
Additional Taxonomies | 101Y00000X Counselor (Licence: FL SW17976) |
101Y00000X Counselor | |
Enumeration Date | 2020-11-10 |
Last Update Date | 2023-06-20 |