| NPI | 1588963573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW28772) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA LCS 28772) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2022-09-28 |