| NPI | 1629421086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 107688) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 12706) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2024-09-13 |