| NPI | 1285764795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 22362) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2021-10-18 |