NPI | 1922473875 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW102621) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
101YM0800X Counselor, Mental Health (Licence: CA 78680) | |
Enumeration Date | 2015-12-03 |
Last Update Date | 2021-10-14 |