| NPI | 1780194779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW107352) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW77952) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2022-04-09 |