| NPI | 1851673032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 76579) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2018-09-12 |