| NPI | 1336315423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L4602) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 24094) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2016-01-18 |