| NPI | 1841649936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 121942) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 97168) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2024-04-19 |