NPI | 1578028254 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 99161) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2019-02-06 |
Last Update Date | 2021-01-22 |