| NPI | 1215124193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW29726) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 29726) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2023-12-08 |