NPI | 1932663374 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MS C10483) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
Enumeration Date | 2019-01-30 |
Last Update Date | 2024-07-29 |