NPI | 1780085043 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 89178) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW66588) |
Enumeration Date | 2014-09-05 |
Last Update Date | 2022-05-01 |