| NPI | 1245667880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 77008) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 36466) |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2018-12-31 |