| NPI | 1700451531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 109659) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 78110) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2022-12-13 |