NPI | 1922133719 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW1099) |
Enumeration Date | 2007-02-22 |
Last Update Date | 2020-12-28 |