| NPI | 1548366396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 18996) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: CA PPSC) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-08 |