| NPI | 1124184395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123908) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 25909) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2024-03-06 |