| NPI | 1154481422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 11527) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 11527) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2019-03-13 |