| NPI | 1134541105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101349) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 35462) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2021-10-28 |