NPI | 1750662854 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 72495) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2011-09-01 |
Last Update Date | 2023-08-21 |