NPI | 1629297395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC COO5639) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC COO5639) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2007-07-08 |