NPI | 1306274576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ACSW94083) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
225400000X Rehabilitation Practitioner (Licence: CA 60138) | |
Enumeration Date | 2013-10-24 |
Last Update Date | 2021-04-30 |