| NPI | 1134209968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 17788) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 1018789) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2018-02-27 |