| NPI | 1770606832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 69082) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 16226) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2018-04-23 |