| NPI | 1962450510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 27596) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149-001413) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-02-12 |