NPI | 1124328406 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 85914) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LCSW85914) |
Enumeration Date | 2010-11-02 |
Last Update Date | 2019-09-05 |