NPI | 1962707950 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 1000-125) |
Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 2221-123) |
Enumeration Date | 2011-01-21 |
Last Update Date | 2018-05-08 |