| NPI | 1235372095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 112845) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 5519) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2023-01-20 |