NPI | 1184286593 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW115829) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW90266) |
Enumeration Date | 2019-07-05 |
Last Update Date | 2024-10-15 |