NPI | 1891355707 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114249) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW89801) |
Enumeration Date | 2019-06-13 |
Last Update Date | 2023-10-25 |