| NPI | 1003175167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW22509) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY LCSW1639) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2024-04-25 |