| NPI | 1285963249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 78852) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AR 658-M) |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2021-09-17 |