| NPI | 1740432475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 89040) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 112208) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2024-12-05 |