NPI | 1316103427 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 71400) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 31106) |
Enumeration Date | 2008-07-29 |
Last Update Date | 2021-05-06 |