NPI | 1447697909 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 80638) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 11818) |
Enumeration Date | 2013-05-23 |
Last Update Date | 2018-04-24 |