NPI | 1689176448 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 88823) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 75930) |
Enumeration Date | 2018-03-07 |
Last Update Date | 2022-08-12 |