NPI | 1689833113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 108983) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 94742) |
Enumeration Date | 2008-06-09 |
Last Update Date | 2024-07-10 |