NPI | 1861962235 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW103794) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW85762) |
Enumeration Date | 2018-11-28 |
Last Update Date | 2025-06-12 |