NPI | 1851673032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 76579) |
Additional Taxonomies | 251S00000X Community/Behavioral Health |
Enumeration Date | 2011-09-14 |
Last Update Date | 2018-09-12 |