| NPI | 1932230562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 24919) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW 24919) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2021-11-30 |