NPI | 1265455737 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCS4334) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA LCS4334) |
Enumeration Date | 2006-07-25 |
Last Update Date | 2018-09-25 |