NPI | 1740708080 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 104158) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2017-09-07 |
Last Update Date | 2024-09-30 |