NPI | 1124779582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 108710) |
Additional Taxonomies | 104100000X Social Worker (Licence: CA 108710) |
261QM0850X Clinic/Center, Adult Mental Health | |
Enumeration Date | 2022-01-17 |
Last Update Date | 2024-09-06 |