| NPI | 1649260670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW74209) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I0008822) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2022-07-21 |