| NPI | 1609313329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 75593) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2021-02-18 |