NPI | 1396041232 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 72943) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 72943) |
Enumeration Date | 2011-02-09 |
Last Update Date | 2019-07-30 |