NPI | 1679096556 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 74767) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW74767) |
Enumeration Date | 2017-07-21 |
Last Update Date | 2017-11-29 |