NPI | 1477044931 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114243) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 80338) |
Enumeration Date | 2018-05-21 |
Last Update Date | 2023-06-07 |