| NPI | 1871862516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS28974) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 21061) |
| Enumeration Date | 2011-12-27 |
| Last Update Date | 2021-03-03 |