| NPI | 1083044960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW72308) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 9006-C) |
| 1041C0700X Social Worker, Clinical (Licence: AR 7896-C) | |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2024-09-12 |