| NPI | 1750719480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW74014) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 129074-121) |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2023-08-31 |