| NPI | 1497011241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW8876) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA LCS 8876) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2017-01-27 |