NPI | 1235539792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100743) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW71862) |
Enumeration Date | 2014-09-02 |
Last Update Date | 2022-07-14 |