| NPI | 1104371764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA lcsw85373) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2019-05-08 |