NPI | 1528390234 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 29211) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW23747) |
Enumeration Date | 2010-02-04 |
Last Update Date | 2013-01-25 |