| NPI | 1699085407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW82346) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 2632-C) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2023-04-17 |