NPI | 1922210061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09925560) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2007-05-03 |
Last Update Date | 2019-05-07 |