| NPI | 1588017628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 71620) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 16820) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2021-12-03 |