| NPI | 1639415276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 6460) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS21512) |
| Enumeration Date | 2013-01-01 |
| Last Update Date | 2018-03-21 |