NPI | 1720428295 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC PO15578) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P007860) |
1041S0200X Social Worker, School (Licence: NC P007860) | |
Enumeration Date | 2013-06-28 |
Last Update Date | 2023-02-07 |