| NPI | 1629152376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCS24329) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 12370) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-12-02 |