NPI | 1760902597 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 96158) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 61718) |
Enumeration Date | 2017-06-22 |
Last Update Date | 2021-11-23 |