NPI | 1992022503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801005274) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6801005274) |
Enumeration Date | 2010-04-23 |
Last Update Date | 2010-04-23 |