NPI | 1780186411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: DC LC302142) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
Enumeration Date | 2018-03-08 |
Last Update Date | 2024-09-19 |