NPI | 1801307749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101867) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ACSW83081) |
Enumeration Date | 2017-10-18 |
Last Update Date | 2021-07-16 |