NPI | 1962015677 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 132365) |
Additional Taxonomies | 104100000X Social Worker |
104100000X Social Worker (Licence: CA 97209) | |
101YM0800X Counselor, Mental Health (Licence: CA 97209) | |
Enumeration Date | 2020-08-24 |
Last Update Date | 2025-07-25 |