NPI | 1518361666 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 94664) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 62955) |
Enumeration Date | 2014-10-17 |
Last Update Date | 2020-04-28 |