NPI | 1063727105 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW69400) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW32706) |
Enumeration Date | 2010-08-12 |
Last Update Date | 2021-03-17 |