| NPI | 1659666055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW29151) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW28147) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2023-01-04 |