| NPI | 1699100511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 27403) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2019-11-20 |