NPI | 1235562703 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW90531) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ACSW 72172) |
Enumeration Date | 2013-08-19 |
Last Update Date | 2021-04-27 |