NPI | 1104475128 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 103797) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 83088) |
101YM0800X Counselor, Mental Health (Licence: CA 103797) | |
Enumeration Date | 2019-09-11 |
Last Update Date | 2023-04-11 |