| NPI | 1235261876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 27485) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW18478) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2011-07-11 |