NPI | 1457687071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 117149) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
Enumeration Date | 2009-11-02 |
Last Update Date | 2014-08-28 |