NPI | 1639787666 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI 5242) |
Additional Taxonomies | 101Y00000X Counselor |
101Y00000X Counselor (Licence: HI no5242) | |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2020-07-15 |
Last Update Date | 2025-04-27 |