NPI | 1821342056 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 109824) |
Additional Taxonomies | 101Y00000X Counselor |
101YM0800X Counselor, Mental Health (Licence: CA 90062) | |
104100000X Social Worker (Licence: CA 90062) | |
Enumeration Date | 2012-11-09 |
Last Update Date | 2023-01-09 |