| NPI | 1235259821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 25647) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 14726) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2009-07-07 |