NPI | 1306366075 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100741) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 77352) |
Enumeration Date | 2017-06-23 |
Last Update Date | 2021-06-25 |