| NPI | 1598091217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS26055) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC303344) |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2009-10-30 |