| NPI | 1609941947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 25198) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 12558) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2015-04-01 |