NPI | 1669885380 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW82182) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 66530) |
101YM0800X Counselor, Mental Health (Licence: NE 10270) | |
1041C0700X Social Worker, Clinical (Licence: CA 66530) | |
1041C0700X Social Worker, Clinical (Licence: NE 6926) | |
Enumeration Date | 2014-06-10 |
Last Update Date | 2018-09-19 |