| NPI | 1225554835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW75139) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW09924860) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2022-07-21 |