NPI | 1639625221 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 105644) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
Enumeration Date | 2016-09-01 |
Last Update Date | 2022-07-18 |