| NPI | 1558492140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7804) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 24198) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2023-02-17 |