NPI | 1750830303 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VT 089.0134396) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
Enumeration Date | 2016-09-23 |
Last Update Date | 2021-10-28 |