| NPI | 1669580296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW66517) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149009132) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2015-07-28 |