NPI | 1073160214 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 120503) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 96364) |
Enumeration Date | 2019-08-22 |
Last Update Date | 2024-05-08 |