| NPI | 1336579150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 70385) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 37359) |
| 1041C0700X Social Worker, Clinical (Licence: TN LCSW 4642) | |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2022-04-21 |