| NPI | 1336699297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW91445) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34010498A) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2024-01-04 |