NPI | 1396768271 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LCS19179) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 19179) |
Enumeration Date | 2006-07-25 |
Last Update Date | 2023-02-08 |