NPI | 1639630353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61294753) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2019-03-26 |
Last Update Date | 2024-06-24 |