NPI | 1922332899 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111964) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 83839) |
Enumeration Date | 2009-09-25 |
Last Update Date | 2022-12-08 |