NPI | 1174138085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 133407) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 133407) |
Enumeration Date | 2020-09-09 |
Last Update Date | 2025-09-03 |