| NPI | 1881025302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 86426) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C011880) |
| 1041C0700X Social Worker, Clinical (Licence: MD 15681) | |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2023-02-26 |