| NPI | 1265990808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 83761) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI 3854) |
| Enumeration Date | 2019-03-02 |
| Last Update Date | 2019-03-02 |