NPI | 1770669244 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW84528) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW 30811) |
Enumeration Date | 2006-10-27 |
Last Update Date | 2020-12-16 |