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 |