NPI | 1518003078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL ISW2250) |
Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL ISW2250) |
Enumeration Date | 2007-01-30 |
Last Update Date | 2022-02-22 |