| NPI | 1750563193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS24100) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW24100) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2018-08-06 |