| NPI | 1386902021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 20729) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW60058525) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2013-06-28 |