NPI | 1720541188 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2130) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 5224) |
1041C0700X Social Worker, Clinical (Licence: NE 10807) | |
Enumeration Date | 2019-04-11 |
Last Update Date | 2022-02-02 |