NPI | 1790034486 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ND 5222) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME MC14322) |
Enumeration Date | 2012-09-10 |
Last Update Date | 2022-01-26 |