| NPI | 1578797437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW#23821) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 4309) |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2012-10-12 |