NPI | 1740510361 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111950) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 37916) |
Enumeration Date | 2010-01-04 |
Last Update Date | 2023-05-01 |