| NPI | 1558606673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 61930) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 05826) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2025-03-19 |