| NPI | 1710106356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 76911) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW34151) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2024-11-11 |