| NPI | 1750860904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 126084) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 91497) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2024-11-04 |