| NPI | 1548399595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 69300) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 26804) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2021-05-06 |