| NPI | 1508101445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6777) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 84551) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2021-10-20 |