NPI | 1578010328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 97172) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
1041C0700X Social Worker, Clinical (Licence: CA 77186) | |
Enumeration Date | 2016-09-08 |
Last Update Date | 2020-10-16 |