| NPI | 1366195778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 96203) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 92603) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2023-01-03 |