NPI | 1043804511 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 99455) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 121584) |
Enumeration Date | 2021-02-25 |
Last Update Date | 2024-03-19 |