NPI | 1104440163 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 116319) |
Additional Taxonomies | 104100000X Social Worker (Licence: CA 96963) |
101YM0800X Counselor, Mental Health (Licence: CA 96963) | |
Enumeration Date | 2020-06-04 |
Last Update Date | 2023-07-12 |