NPI | 1134534407 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 89604) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 72097) |
Enumeration Date | 2014-06-25 |
Last Update Date | 2021-06-02 |