| NPI | 1023360831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 34118) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW10413) |
| 1041C0700X Social Worker, Clinical (Licence: CA 68084) | |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2022-07-22 |