NPI | 1619693785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 081394) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 081394) |
Enumeration Date | 2022-10-19 |
Last Update Date | 2024-10-17 |