| NPI | 1770108433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 108203) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW16306) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2024-07-23 |