NPI | 1841548948 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW79801) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-08-21 |
Last Update Date | 2018-03-17 |