NPI | 1467939553 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 15872) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
101YM0800X Counselor, Mental Health (Licence: CA 6593) | |
Enumeration Date | 2018-07-23 |
Last Update Date | 2024-07-03 |