NPI | 1962671800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 65726) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2008-02-25 |
Last Update Date | 2017-05-11 |