NPI | 1861700676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 107715) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
1041C0700X Social Worker, Clinical (Licence: NJ 44SC05416100) | |
Enumeration Date | 2010-09-15 |
Last Update Date | 2022-11-21 |