| NPI | 1679847263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 27838) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW21123) |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2023-08-10 |