| NPI | 1144476474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 108025) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ 22006) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2024-06-17 |