NPI | 1659623585 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW84625) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
101YM0800X Counselor, Mental Health (Licence: CA ASW62103) | |
Enumeration Date | 2012-10-02 |
Last Update Date | 2018-08-20 |