NPI | 1952432056 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 27635) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 27635) |
1041S0200X Social Worker, School (Licence: CA 27635) | |
Enumeration Date | 2007-03-08 |
Last Update Date | 2012-04-27 |