NPI | 1043525306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW82321) |
Additional Taxonomies | 101Y00000X Counselor |
101YM0800X Counselor, Mental Health (Licence: CA ASW63240) | |
Enumeration Date | 2010-08-11 |
Last Update Date | 2019-08-19 |