| NPI | 1376914960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 84439) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 66815) |
| 104100000X Social Worker (Licence: CA 84439) | |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2022-05-19 |