NPI | 1841590064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW72959) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 28976) |
101YM0800X Counselor, Mental Health (Licence: CA Asw28967) | |
Enumeration Date | 2010-10-22 |
Last Update Date | 2016-09-09 |