| NPI | 1679960090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LMSW-15401) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW60775) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2016-03-02 |