NPI | 1902171242 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 107247) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2012-03-20 |
Last Update Date | 2022-03-17 |