| NPI | 1255405320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7835-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 17168) |
| 1041C0700X Social Worker, Clinical (Licence: CA LCSW27688) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2019-01-31 |