NPI | 1740909928 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW129982) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 109413) |
1041C0700X Social Worker, Clinical (Licence: CA ACSW109413) | |
Enumeration Date | 2022-08-23 |
Last Update Date | 2025-05-16 |