| NPI | 1093069536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW62392) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA ASW26070) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2024-01-25 |