NPI | 1134358401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 102010) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 24764) |
Enumeration Date | 2009-07-08 |
Last Update Date | 2022-04-25 |