NPI | 1750438081 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW27815) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 18012) |
Enumeration Date | 2007-01-05 |
Last Update Date | 2021-07-01 |