| NPI | 1619580057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW96008) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C009649) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2021-02-17 |