| NPI | 1376257428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 115984) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 5218C) |
| Enumeration Date | 2023-01-12 |
| Last Update Date | 2024-07-28 |