NPI | 1710300710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW124574) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 83183) |
171M00000X Case Manager/Care Coordinator | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-01-27 |
Last Update Date | 2024-07-30 |