| NPI | 1902901432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 17984) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI LCSW 3612) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-01-24 |