NPI | 1164035762 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 82308) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 82308) |
Enumeration Date | 2020-08-25 |
Last Update Date | 2023-11-06 |