NPI | 1154670891 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 87573) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2012-09-07 |
Last Update Date | 2021-03-09 |