NPI | 1053608570 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 61051) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 28065) |
Enumeration Date | 2011-07-05 |
Last Update Date | 2016-12-13 |