| NPI | 1316150717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW10612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A6235) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2021-04-14 |