| NPI | 1679997134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005582) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS18569) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2016-12-21 |