NPI | 1528840519 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Additional Taxonomies | 104100000X Social Worker |
Enumeration Date | 2023-10-16 |
Last Update Date | 2023-11-29 |