| NPI | 1013048123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 8679) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 27425) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2024-10-31 |