| NPI | 1467945493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 112411) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 91386) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2023-09-26 |