NPI | 1871079665 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW121455) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 104512) |
104100000X Social Worker (Licence: CA 104512) | |
Enumeration Date | 2018-07-14 |
Last Update Date | 2024-03-20 |