| NPI | 1114285814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 104085) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 3534) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2023-08-22 |