NPI | 1174883946 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 107448) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW88766) |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2012-05-25 |
Last Update Date | 2023-08-23 |