| NPI | 1710008735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW69500) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 15587) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2021-11-30 |