NPI | 1245384833 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW27639) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW20317) |
Enumeration Date | 2007-01-22 |
Last Update Date | 2011-09-26 |