| NPI | 1770885964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 22255) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I 1017) |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2014-02-25 |