| NPI | 1912259540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW79952) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 32931) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2022-06-01 |