NPI | 1992163034 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101795) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 84644) |
Enumeration Date | 2016-02-03 |
Last Update Date | 2023-09-26 |