NPI | 1316596026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 104100000X Social Worker (Licence: CA 109377) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 109377) |
1041C0700X Social Worker, Clinical (Licence: CA 109377) | |
106S00000X Behavior Technician | |
Enumeration Date | 2019-09-05 |
Last Update Date | 2024-08-07 |