| NPI | 1114644044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111220) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 111220) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2022-10-24 |