NPI | 1023462728 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 102727) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2016-04-19 |
Last Update Date | 2021-11-23 |